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Présentation de l’équipe de Neuro-Radiologie Interventionnelle

L'équipe médicale NRI

Unité de Neuroradiologie Interventionnelle

Dr Richard BIBI

Responsable d’unité

Pr Denis HERBRETEAU

Professeur des Universités  Praticien Hospitalier

Dr Grégoire BOULOUIS

 Praticien Hospitalier

Dr Héloïse IFERGAN

Praticien Hospitalier

Dr Kevin JANOT

Dr Fouzi BALA

Service de Radiologie, Neuroradiologie Diagnostique Interventionnelle

Docteur Baptiste MOREL

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Pr Laurent BRUNEREAU

Chef de Pôle Imagerie

L’équipe est composée par ailleurs de :

• 14  manipulateurs d’électroradiologie médicale,
• 5 secrétaires dédiées,
• 2 attachés de recherche clinique.

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Discipline(s)

Cardiovascular magnetic resonance in heart transplant patients: diagnostic value of quantitative tissue markers: T2 mapping and extracellular volume fraction, for acute rejection diagnosis

Affiliations.

• 1 Department of Cardiothoracic Surgery, University François Rabelais, Tours, France. [email protected].
• 2 Department of Radiology, University François Rabelais, Tours, France. [email protected].
• 3 Department of Cardiothoracic Surgery, University François Rabelais, Tours, France.
• 4 Department of Radiology, University François Rabelais, Tours, France.
• 5 Department of Anatomopathology, University François Rabelais, Tours, France.
• PMID: 30153847
• PMCID: PMC6114788
• DOI: 10.1186/s12968-018-0480-9

Background: The diagnosis of acute rejection in cardiac transplant recipients requires invasive technique with endomyocardial biopsy (EMB) which has risks and limitations. Cardiovascular magnetic resonance imaging (CMR) with T2 and T1 mapping is a promising technique for characterizing myocardial tissue. The purpose of the study was to evaluate T2, T1 and extracellular volume fraction (ECV) quantification as novel tissue markers to diagnose acute rejection.

Methods: CMR was prospectively performed in 20 heart transplant patients providing 31 comparisons EMB-CMR. CMR was performed close to EMB. Images were acquired on a 1.5 Tesla scanner including T2 mapping (T2 prepared balanced steady state free precession) and T1 mapping (modified Look-Locker inversion recovery sequences: MOLLI) at basal, mid and apical level in short axis view. Global and segmental T2 and T1 values were measured before and 15 min (for T1 mapping) after contrast administration.

Results: Acute rejection was diagnosed in seven patients: six cellular rejections (4 grade IR, 2 grade 2R) and one antibody mediated rejection. Patients with acute rejection had significantly higher global T2 values at 3 levels: 58.5 ms [55.0-60.3] vs 51.3 ms [49.5-55.2] (p = 0.007) at basal; 55.7 ms [54.0-59.7] vs 51.8 ms [50.1-53.6] (p = 0.002) at median and 58.2 ms [54.0-63.7] vs 53.6 ms [50.8-57.4] (p = 0.026) at apical level. The area under the curve (AUC) for each level was 0.83, 0.79 and 0.78 respectively. Patients with acute rejection had significantly higher ECV at basal level: 34.2% [32.8-37.4] vs 27.4% [24.6-30.6] (p = 0.006). The AUC for basal level was 0.84. The sensitivity, specificity and diagnosis accuracy for basal T2 (cut off: 57.7 ms) were 71, 96 and 90% respectively; and for basal ECV: (cut off 32%) were 86, 85 and 85% respectively. Combining basal T2 and basal ECV allowed diagnosing all acute rejection and avoiding 63% of EMB.

Conclusions: In heart transplant patients, a combined CMR approach using T2 mapping and ECV quantification provides a high diagnostic accuracy for acute rejection diagnosis and could potentially decrease the number of routine EMB.

Keywords: Acute cardiac rejection; Cardiovascular magnetic resonance; Endomyocardial biopsy; T1 and T2 mapping.

• Acute Disease
• Case-Control Studies
• Graft Rejection / diagnostic imaging*
• Graft Rejection / immunology
• Graft Rejection / pathology
• Heart Transplantation / adverse effects*
• Magnetic Resonance Imaging*
• Middle Aged
• Myocardium / pathology*
• Predictive Value of Tests
• Prospective Studies
• Reproducibility of Results
• Risk Factors
• Treatment Outcome

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• v.108(1); 2014 Jan

Unusual multiple large abscesses of the liver: interest of the radiological features and the real-time PCR to distinguish between bacterial and amebic etiologies

Guillaume desoubeaux.

1 CHU de Tours, Service de Parasitologie – Mycologie – Médecine tropicale, Tours, France

2 Université François Rabelais, CEPR – INSERM U1100 / E.A. 6305, Faculté de Médecine, Tours, France

Hélène Chaussade

3 CHU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France

Marc Thellier

4 CHU La Pitié-Salpêtrière, Laboratoire de Parasitologie – Mycologie, Paris, France

5 Université Pierre et Marie Curie, INSERM U511 / UMR S945 Paris VI, France

6 INSERM U511 / UMR-S 945, Paris, France

Sophie Poussing

Frédéric bastides, eric bailly, philippe lanotte.

7 CHU de Tours, Laboratoire de Bactériologie, Tours, France

8 Université François Rabelais, E5 “Bactéries et risque materno-foetal”, UMR 1282 ISP, INRA, Nouzilly, France

Daniel Alison

9 CHU de Tours, Service de Radiologie Adulte, Tours, France

Laurent Brunereau

Louis bernard, jacques chandenier.

We report a rare case of amebiasis generating 19 large liver abscesses. Such a quantity of abscesses is rare, especially when occurring in a young casual traveler without any immunodeficiency disorders. A possible co-infection was excluded. By contrast, the amebic etiology was confirmed by means of serology and real-time PCR.

Case Report

We report the case of a 36-year-old Caucasian man with febrile diarrhea who presented with a loss of appetite and a severe asthenia. His past medical history was insignificant, and he was up to date with his vaccines. As military personnel in the French army, he had frequently traveled to the French West Indies, French Polynesia, and Senegal during the last 10 years. In the month preceding his hospitalization, he went on a trip to Dakar, Senegal, and then to Martinique in the French West Indies. During these trips he did not take his anti-malarial medical treatment correctly (chemoprophylaxis atovaquone–proguanil). He presented with a fever of 38–40°C, chills, sweats, and myalgia, which were not relieved by taking paracetamol, 4 days after his return to mainland France. The lab report excluded malaria. Parasitological examination of stools and bacterial coprocultures remained negative.

Despite the empirical use of antibiotics (amoxicillin–clavulanic acid), the patient’s symptoms became more severe with hepatomegaly and tender abdomen, particularly in the right upper quadrant. A biological inflammatory syndrome (neutrophil granulocytes  =  14.38 g/l; CRP  =  419 mg/l) and a hepatic cytolysis with moderate cholestasis were noticed (AST  =  91 UI/l; ALT  =  44 UI/l; ALP  =  108 UI/l; gamma-GT  =  66 UI/l). Ceftriaxone was thereafter added to his treatment. The ultrasound scan showed multiple liver hypoechoic lesions with echoic walls, and a hypertrophy of the right liver (length×depth  =  20×12 cm) ( Fig. 1 ). An abdominal computed tomography (CT) confirmed the presence of several large hypodense rounded masses ( Fig. 2 ). The inside aspect of the masses seemed to be made up of a heterogeneous liquid, and their edges were irregular. The presence of at least 19 abscesses was observed. The largest lesion measured 96 mm and was located between the V and VI hepatic segments. The smallest one was 40 mm wide. There was no contrast enhancement after injection of intravenous contrast agent. Pan colitis and radiological cholestasis were also observed.

Abdominal ultrasonography showing multiple rounded hypoechoic lesions.

Abdominal-computed tomography (CT) portal-phase showing large hypodense abscesses in all the hepatic segments (helical acquisition; dose length product  =  3494 mGy/cm; IV injection of 140 ml iohexol, Omnipaque 350 ® ). The 19 abscesses are individually labeled by large arrows. Edges were irregular, and the content appeared fluid and heterogeneous.

The serology targeting amebiasis was positive: hemagglutination positive at 1∶1280 dilution (IHA Amœbiasis™, Fumouze Diagnostics, Levallois-Perret, France), and indirect immunofluorescence at 1∶800 (Amœba-Spot IF™, BioMérieux, Craponne, France). Concomitantly, all the blood cultures remained sterile. Thereby, an anti-amebic therapy was initiated, based on metronidazole administration at 500 mg tid for 21 days, followed by a luminal amebicide (tiliquinol/tilbroquinol). Within 48 hours the patient had no more fever and his diarrhea had nearly stopped. Neutrophil granulocytes and CRP rate decreased in less than 1 week, to 9.33 g/l and 54 mg/l respectively.

As the patient was still complaining of persistent abdominal pains, a puncture of the painful abscess under the hepatic capsule was performed under CT-guidance ( Fig. 3 ). Standard cultures and the pan-bacterial real-time PCR, targeting the 16S rDNA which were performed directly on the aspirated liquid were all negative. In contrast, the PCR specific for Entamoeba histolytica (16S-like SSU rDNA) was positive ( C t  =  27 cycles; standard deviation  =  0.104). Briefly, the DNA was extracted using QIAmp DNA mini kit® spin columns (Qiagen™, Courtaboeuf, France). The method performed for amplification and detection was a real-time PCR using a TaqMan 7500® Fast Real-Time PCR System (Applied Biosystems™, Saint Aubin, France). The amplification reactions were performed using 5 μl of a DNA sample in a volume of 20 μl of a mixture that contained a TaqMan Fast Universal PCR Master Mix® (2×) (Applied Biosystems), internal positive control (Applied Biosystems), and the primers for E. histolytica : Eh-196F (5′-AAA TGG CCA ATT CAT TCA ATG A-3′) and Eh-294R (5′-CAT TGG TTA CTT GTT AAA CAC TGT GTG-3′), and the probe Eh-245 (6FAM)-AGG ATG CCA CGA CAA-(NFQ). The thermal cycling conditions were chosen according to TaqMan® Fast protocol (Applied Biosystems) and it consisted of 20 seconds at 95°C followed by 50 cycles of 3 seconds at 95°C, and 30 seconds at 60°C. The detection and the data analysis were performed with TaqMan Fast 7500 software (Applied Biosystems) version 1.4.0.

Computed tomography (CT)-guided aspiration of one of the more accessible abscess showing a sterile brown-purulent liquid. The punctured abscess was located under the capsule in the hepatic segment VI, and initially measured 78×54×80 mm. (A) The aspiration was performed laterally by the means of a trocar (large yellow arrow <$>\vskip-1\scale 80%\raster="rg1"\<$>). (B) The color of the 250 ml harvested fluid appeared macroscopically similar to milk chocolate. (C) The light microscopic observation showed only purulent material with a few degranulated leukocytes (→) and some altered red blood cells (→), but no viable Entamoeba histolytica trophozoites (magnification ×400).

The 6-month follow-up was satisfactory. Neither clinical relapse nor subsequent biological perturbations were noticed. There was a substantial decrease in the size of the liver abscesses. However, the number of lesions persisted.

Amebiasis is a tropical food- and water-borne parasitosis due to the human-specific protozoan E. histolytica. 1 Its worldwide prevalence is estimated at 500 million infected individuals, especially those living in developing countries with low socio-economic level and poor hygienic status. 1 , 2 Potential complications are caused by the trophozoite stage that generates ulceration of the colon and leads to bowel perforations. This first step of invasion could be followed by the hematogeneous dissemination of trophozoites toward organs where abscesses are constituted. Thus, liver abscesses are by far the most common extra-intestinal manifestation of invasive amebiasis. 3 , 4

Although hepatic ultrasound scan is widely used, 5 an abdominal-CT enables a better result allowing more than a 95% detection rate of smaller abscesses and any other associated complications. 6 Amebic abscesses are usually single and are normally located in the right hepatic lobe. 1 , 7 Multiples lesions sometimes occur, but they are infrequently reported. By contrast, a great number of liver abscesses are commonly associated with bacterial etiologies. In 2004, 577 medical records were retrospectively reviewed in order to identify features distinguishing amebic liver abscesses from pyogenic ones. 8 Multivariate analysis found that multiple abscesses are more likely to be associated with pyogenic origin (adjusted odds ratio  =  5.34 [2.86–9.96], P < 0.001). Owing to the very unusual tomodensitometric presentation exhibiting 19 large abscesses, the initial hypothesis of a bacterial co-infection was thereafter obviously raised for our patient. Nevertheless, the bio-clinical investigations did not provide evidence of any bacterial involvement: no germs were isolated, 9 and the initial use of antibiotics (i.e. amoxicillin–clavulanic acid, then ceftriaxone) had no effect on the fever or the pain. To our knowledge, such a number of large lesions as a result of an amebic infection have rarely been reported, especially in the case of a young short trip traveler. An interesting reported case referred to 25 amebic liver abscesses in a Belgian woman. 10 However, as she used to live permanently in an endemic area of amebiasis, she was thereby continuously exposed to iterative infections. Excepting this isolated case, observations of multiple amebic liver abscesses have globally remained rare in all the cohorts, and were then limited to a maximum of five or six abscesses, whereas the solitary abscesses represented 65–90% of all these cases. 7 , 11 – 18 Besides, in all these studies, multiples abscesses preferentially occurred in concomitant immunocompromised patients, e.g. HIV-infection, 19 , 20 or in cases of advanced amebiasis, e.g. in subjects exposed to recurrent amebic infections. 3 In our situation, the patient wasn’t known to be immunocompromised, and had only short stays in highly endemic areas of amebiasis.

The present case demonstrates that percutaneous puncture–aspiration enabled the disruption of pain, which was mainly due to abdominal tension induced by the numerous large abscesses. Furthermore, the percutaneous drainage had also a diagnostic role, since the real-time PCR done on the liquid was important in confirming that this was a case of active invasive amebiasis.

According to some authors, image-guided needle aspiration has an evacuation role, and should be considered when there is no clinical improvement after 3 days of taking metronidazole. 21 – 23 It is interesting to note that residual abscesses may persist in 5–28% of cases and remain so for up to 13 years, and this in spite of taking an effective treatment. 24 , 25 In such situations, there is neither fever nor abdominal pain nor jaundice. 4 , 26

Exceptionally numerous large abscesses could be seen during hepatic amebiasis. Faced with such an unusual abdominal-CT scan findings, the use of amebic serology may be of great interest. Furthermore, the real-time PCR test is now considered a smart diagnostic tool. In complicated amebiasis, the percutaneous puncture–aspiration should be considered as an interesting complement to conventional anti-amebic chemotherapy.

Written informed consent was obtained from the patient for publication of this report and any accompanying images.

Financial Support

All authors declare no ongoing financial support. Authors did not receive any funding for the study.

Data have been collected as part of the routine work of University Hospital of Tours.

Transparency Declarations and Conflict of Interest

All authors declare no financial conflict of interest. No funder has played any decision-making role in the research.

All authors have brought their substantial contributions to research design, or the acquisition, analysis, or interpretation of data. They all have been involved in drafting the paper or revising it critically. All authors declare to have given their agreement for the final submission. They confirm that the manuscript is not under editorial consideration in another journal.

The editors have our permission to reproduce any content of the article, after potential acceptation.

Acknowledgments

The authors would like to thank Dr Oussama Mouri (Pitié-Salpêtrière, Paris – France) for his precious help in the implementation of the Entameba dispar/histolytica PCR. The authors are very grateful to Donam Kim, Jérôme Desoubeaux, and Kay Mc Carthy-Cerf from the Pedagogical Department of English learning in the Medical School of Tours University for their precious help with the English translation.

Liver shear wave elastography and attenuation imaging coefficient measures: prospective evaluation in healthy children

• Hepatobiliary
• Published: 08 June 2021
• Volume 46 , pages 4629–4636, ( 2021 )

Cite this article

• Romain Cailloce 1 ,
• Elsa Tavernier 2 ,
• Laurent Brunereau 3 ,
• Adèle Fievet 1 ,
• Céline Falip 1 ,
• Fanny Dujardin 4 ,
• Stéphanie Willot 5 ,
• Frédéric Patat 2 , 3 &
• Baptiste Morel   ORCID: orcid.org/0000-0003-4747-3393 1 , 6  

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Ultrasonographic quantitative measurements enable characterizing the stiffness and viscosity of liver parenchyma. Normal Shear Wave Elastography (SWE) values have been reported in adults and children. The Attenuation Imaging (ATI) coefficient is a measure of local sound energy loss thought to reflect steatosis in adults. The aim of our study was to provide normal SWE and ATI liver values in healthy children.

A prospective monocentric study was conducted recruiting 86 children (45 boys and 41 girls) from a single University Hospital between January 2019 and June 2020, having a clinically indicated ultrasound examination, without a known or documented history of liver disease. Examinations were performed using an Aplio i800 (Canon Medical Systems) ultrasound system with an i8CX1 transducer. SWE measurements were obtained using a color map showing an automated measurement area grid overlay. ATI coefficients were generated automatically for each region of interest in the right liver.

Overall median age for the pediatric population was 106 months (1–180 months; SD 49 months). Children were normal weighted. Liver SWE was available for all children. The median liver SWE was 4.6 kPa [3.3–6.6]. ATI yielded valid measurements in 77 patients. The median ATI coefficient was 0.65 [0.5–0.81] dB/cm/MHz. No impact of age, sex, weight and Body Mass Index was observed.

SWE and ATI liver values were provided in healthy children. The normative quantitative data might be useful to characterize liver parenchyma in children better.

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Reference values of normal liver stiffness in healthy children by two methods: 2D shear wave and transient elastography

Performance of two--dimensional ultrasound shear wave elastography: reference values of normal liver stiffness in children

Two-dimensional ultrasound shear wave elastography for identifying and staging liver fibrosis in pediatric patients with known or suspected liver disease: a clinical effectiveness study

Abbreviations.

Attenuation imaging coefficient

Shear wave dispersion

• Shear wave elastography

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Acknowledgements

The authors thank the pediatric patients and their parents who agreed to contribute to the study. The authors acknowledge Mr Jean Laurent Lasquellec for his invaluable technical support and Mr John Sheath for his English language assistance. Thanks to Marie Moinier, Madeleine and Capucine. Thanks to Linda Dainese.

No funding was secured for this study. The authors have no financial relationships relevant to this article to disclose.

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Pediatric Radiology Department, Clocheville Hospital, CHRU de Tours, 49 Boulevard Beranger, 37000, Tours, France

Romain Cailloce, Adèle Fievet, Céline Falip & Baptiste Morel

Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France

Elsa Tavernier & Frédéric Patat

Radiology Department, CHRU de Tours, Tours, France

Laurent Brunereau & Frédéric Patat

Pathology, Tours University Hospital, University of Tours, Tours, France

Fanny Dujardin

Pediatric Department, Clocheville Hospital, CHRU de Tours, Tours, France

Stéphanie Willot

UMR 1253, iBrain, Inserm, Université de Tours, Tours, France

Baptiste Morel

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We declare that all human and animal studies have been approved by the local institutional review board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study. We obtained approval by the local Ethics Committee in Human research (RNI- 2020_075).

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Cailloce, R., Tavernier, E., Brunereau, L. et al. Liver shear wave elastography and attenuation imaging coefficient measures: prospective evaluation in healthy children. Abdom Radiol 46 , 4629–4636 (2021). https://doi.org/10.1007/s00261-021-02960-w

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Received : 20 November 2020

Revised : 12 January 2021

Accepted : 15 January 2021

Published : 08 June 2021

Issue Date : October 2021

DOI : https://doi.org/10.1007/s00261-021-02960-w

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Julie Martinez a été "blessée" par un reportage de Bernard de la Villardière

Bernard de La Villardière traité d'"'islamophobe" et de "raciste", à son retour de tournage, à l'aéroport de Roissy Charles de Gaulle

Famille expulsée d'un HLM : "Tu dois réfléchir aux conséquences !" déplore Alain Marschall

Pour Zohra Bitan : "Ce n'est pas de l'autorité qu'il faut, c'est épauler les profs !"

Prof frappé par un élève : Pour Didier Giraud il faut mettre en place plusieurs points

"Mathilde Panot argumente ses propos par des mensonges !" déclare Zohra Bitan

"Mathilde Panot n'a rien a faire dans un commissariat !" déclare Olivier Truchot

Paris: Elina Dumont dénonce "un nettoyage social" avant les JO